Sciatic neuropathy (SN) is rarely encountered in the pediatric population. The causes of this mon... more Sciatic neuropathy (SN) is rarely encountered in the pediatric population. The causes of this mononeuropathy are either infectious, immune mediated, toxic, or infiltrative (tumoral). In this article, we presented the case of a 7.5-year-old male child who presented to the emergency department with a painful right lower limb. Magnetic resonance imaging confirmed the diagnosis of subacute osteomyelitis of the ischium, which extended toward the external hip rotators and infiltrated the tissues around the sciatic nerve. Treatment with intravenous antibiotics (flucloxacillin 50 mg/kg/d and gentamicin 10 mg/kg/d) rapidly improved the child's condition and relieved neurological symptoms within a few days. Traumatic and iatrogenic injuries are the most common causes for SN. To our knowledge, this presented case is the first to describe SN due to an infectious process following subacute osteomyelitis.
Introduction: Osteoarticular infections (OAIs) constitute serious paediatric conditions that may ... more Introduction: Osteoarticular infections (OAIs) constitute serious paediatric conditions that may cause severe complications. Identifying the causative organism is one of the mainstays of the care process, since its detection will confirm the diagnosis, enable adjustments to antibiotic therapy and thus optimize outcomes. Two bacteria account for the majority of OAIs before 16 years of age: Staphylococcus aureus is known for affecting the older child, whereas Kingella kingae affects infants and children younger than 4 years old. We aimed to better define clinical characteristic and biological criteria for prompt diagnosis and discrimination between these two OAI. Materials and methods: We retrospectively studied 335 children, gathering 100 K. kingae and 116 S. aureus bacteriologically proven OAIs. Age, gender, temperature at admission, involved bone or joint, and laboratory data including bacterial cultures were collected for analysis. Comparisons between patients with OAI due to K. k...
Nowadays, Kingella kingae (K. kingae) is considered as the main bacterial cause of osteoarticular... more Nowadays, Kingella kingae (K. kingae) is considered as the main bacterial cause of osteoarticular infections (OAI) in children aged less than 48 months. Next to classical acute hematogenous osteomyelitis and septic arthritis, invasive K. kingae infections can also give rise to atypical osteoarticular infections, such as cellulitis, pyomyositis, bursitis, or tendon sheath infections. Clinically, K. kingae OAI are usually characterized by a mild clinical presentation and by a modest biologic inflammatory response to infection. Most of the time, children with skeletal system infections due to K. kingae would not require invasive surgical procedures, except maybe for excluding pyogenic germs’ implication. In addition, K. kingae’s OAI respond well even to short antibiotics treatments, and, therefore, the management of these infections requires only short hospitalization, and most of the patients can then be treated safely as outpatients.
Compartment syndrome is a condition where high pressure within a muscle compartment reduces capil... more Compartment syndrome is a condition where high pressure within a muscle compartment reduces capillary blood perfusion below the level necessary for tissue viability. A variety of injuries and medical conditions may initiate acute compartment syndrome, including fractures, contusions, burns, bleeding disorders, post-ischemic swelling, and gunshot wounds. Exertional compartment syndrome is a well-recognised clinical entity, which can have an acute or chronic presentation, and is associated most often with unaccustomed exercise. This case report discusses a 15-year-old girl who for two years felt transitory pain in the right peroneal compartment when she played sport. After many days of horseback riding, she sustained a sudden increase of the antero-lateral leg pain. The pressure of her lateral leg compartment rose to 100mmHg. Emergent fasciotomy of the lateral compartment of the right leg was performed, and showed partially necrotic peroneal muscles. The reported case is unusual because the pathology was localised to the peroneal compartment only and left the 3 other loges unaffected. Only two other reported cases of exertional compartment syndrome from prolonged horseback riding has been found in the medical literature. The particular mechanism of the peroneal compartment as a result of horseback riding in children is also discussed.
We report an even rarer subtype of this translocation associated with a radial neck fracture and ... more We report an even rarer subtype of this translocation associated with a radial neck fracture and elbow dislocation. This case had clinical importance in that reverse instability was observed compared with the previous reports. Case report A 5-year-old boy was admitted to our emergency center after a fall from a 2 m jungle gym onto his outstretched left hand. The patient complained of left elbow pain and limitation of motion. Initial examination revealed a painful, swollen left elbow without neurovascular problems. The left elbow was held in 50 o flexed position with the forearm in supinated position. The posterior elbow dislocation and radial head fracture were recognized at initial radiographs (Fig. 1). The closed reduction was performed under intravenous sedation and the elbow was immobilized with long arm splint. However, the pain did not subside on the following day and the forearm showed limatation of rotation, especially pronation. The radiographs after reduction were reviewed carefully, and we realized the reversal anatomical relationship of the forearm bone with the humerus. Magnetic resonance image was taken before surgery to evaluate associated soft tissue injury. The radial head was incarcerated between the coronoid process and brachialis insertion (Fig. 2). Closed reduction was planned again. Under general anesthesia, forearm can be extended and supinated, but cannot be pronated beyond the neutral position (Fig. 3). Longitudinal traction and forced supination of the forearm with manual reduction on the radial head failed to achieve reduction. A 1 cm skin incision was made on medial aspect of the proximal ulna. Freer was inserted through the incision, and manual reduction of proximal radius was performed by pushing it laterally (Fig. 4). After reduction, stability of Abstract Proximal radioulnar translocation with radial neck fracture and elbow dislocation is extremely rare. We report a case of a 5-year-old boy who was presented with elbow dislocation, and proximal radioulnar translocation was diagnosed a day after the injury. Mini-open technique was used to reduce the translocation and radial neck fracture. The patient finally regained full range of elbow motion and forearm rotation. This case had clinical importance in that the reverse instability of the elbow was observed compared with the previous reports.
Le signe du carre pronateur est un signe radiologique qui a ete decrit chez l’adulte lors de frac... more Le signe du carre pronateur est un signe radiologique qui a ete decrit chez l’adulte lors de fractures du poignet. En raison des proprietes biomecaniques de l’os en croissance, certaines fractures chez l’enfant sont parfois plus difficilement decelables, raison pour laquelle ce signe est frequemment utilise en pediatrie sans avoir ete valide dans cette population. Par cette etude retrospective cas-temoin, incluant 200 patients, nous avons effectue plusieurs mesures dont l’epaisseur du muscle du carre pronateur et la ligne graisseuse le recouvrant que nous avons normalise au developpement de l’enfant. Les resultats de l’etude confirment qu’il existe une modification du complexe du carre pronateur lors d’une fracture du poignet. Par ailleurs nous avons pu constater que la combinaison entre un epaississement de la ligne graisseuse et une tumefaction du muscle carre pronateur constituaient les criteres morphometriques les plus significatifs et discriminants pour confirmer la presence d’...
Swiss Medical Forum ‒ Schweizerisches Medizin-Forum, 2009
Knochenbrüche an Beinen und Fussgelenken treten bei Kindern und Jugendlichen relativ häufig auf -... more Knochenbrüche an Beinen und Fussgelenken treten bei Kindern und Jugendlichen relativ häufig auf -als Folge von Sportverletzungen oder Unfällen im Strassen verkehr. In der Regel behandelt man solche Brüche konservativ mit einem stabilisierenden Gipsverband. Wegen der fehlenden mechanischen Belastung kann es dann aber zu einem Verlust von Knochenmasse, einem bedeutenden Muskelschwund und in der Folge zu einer Abnahme der Muskelkraft kommen.
Introduction: Mac Farland fracture is a joint fracture of the ankle in children, which involves t... more Introduction: Mac Farland fracture is a joint fracture of the ankle in children, which involves the medial malleolus (Salter-Harris type III or IV) and is frequently associated with a fracture of the distal fibula. These injuries have a major risk of resulting in a medial epiphysiodesis bridge which, in turn, can lead to a varus deformity. As of today, recommended treatment for displacements wider than 2mm is open reduction with screw fixation. The aim of this study is to evaluate functional and radiological results of a new less invasive surgical procedure. Materials and Methods: We retrospectively analyzed a case series of patients who suffered from a Mac Farland fracture and underwent percutaneous screw fixation with arthrographic control. Data collected for each child included age at diagnosis, gender, mechanism and side of injury, radiological Salter-Harris classification of medial and lateral malleolus fracture, size of the fracture line gap before and after treatment, and dur...
Le syndrome douloureux regional complexe (SDRC) est un terme defini par l'Association interna... more Le syndrome douloureux regional complexe (SDRC) est un terme defini par l'Association internationale de l'etude de la douleur afin de decrire une affection douloureuse neurologique affectant un membre et caracterisee par une allodynie, une hyperalgie, des changements neurovasculaires et sudomoteurs, des troubles de la motricite et des changements trophiques cutanes ou ongulaires. Les symptomes peuvent etre divises en deux groupes : les symptomes nocifs positifs, comme l'allodynie et l'hyperalgie, et les symptomes deficitaires negatifs, comme la perte sensorielle et les troubles moteurs. Le SDRC pediatrique differe de la version adulte a bien des egards et cette these passe en revue les specificites pediatriques du SDRC. Les circonstances cliniques precedant un SDRC different tout comme la clinique avec certaines specificites pediatriques telles que l’environnement du patient (famille, ecole), qui constitue un facteur decisif dans la prise en charge des patients pedia...
The authors report a rare case of an unusual primary pyomyositis of the biceps cruralis assigned ... more The authors report a rare case of an unusual primary pyomyositis of the biceps cruralis assigned to Kingella kingae in a 21-month-old girl. The reported case demonstrated that primary pyomyositis may be encountered during invasive infection due to K. kingae even if this manifestation remains rare. This bacterial etiology must, therefore, be evoked when a primary pyomyositis is observed, and this is in particular in children under 4 years of age.
Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 2003
PURPOSE OF THE STUDY Bone and joint infections are challenging therapeutic situations requiring r... more PURPOSE OF THE STUDY Bone and joint infections are challenging therapeutic situations requiring rapid antibiotic therapy as soon as bacteriology specimens have been obtained. Laboratory tests (C reactive protein, erythrocyte sedimentation rate, white cell count) and clinical findings are used to assess therapeutic efficacy. Most of the clinical signs however, particularly in children or after a surgical procedure, are not explicit enough to allow proper assessment of the clinical course under antibiotic therapy. Body temperature is the only parameter currently used in routine practice. But the measurement of body temperature is not always reliable and variations observed during treatment should not always be attributed to treatment failure. The purpose of this work was to assess the significance of changes in body temperature observed in children given effective intravenous antibiotic treatment for bone and joint infections. MATERIAL AND METHODS We reviewed retrospectively the files...
Aim: This retrospective study’s objective was to evaluate osteoarticular infection in infants les... more Aim: This retrospective study’s objective was to evaluate osteoarticular infection in infants less than 12 months of age, with a particular focus on biological features and bacteriological etiology. Material & methods: We retrospectively reviewed the medical records of every infant younger than 12 months old admitted in our institution for a suspected osteoarticular infection between January 1980 and December 2016. Results: Sixty-nine patients records were reviewed, including eight neonates, 16 infants from 1 to 5 months old, and 45 from 6 to 12 months old. Conclusion: Neonates and infants aged from 6 to 12 months old were more exposed to infections. Staphylococcus aureus remained the main pathogen in children <6 months, whereas Kingella kingae has become the most frequently isolated microorganism in infants aged from 6 to 12 months old.
Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and aff... more Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and affect primarily infants and toddlers. Clinical presentation is often vague and nonspecific. Laboratory findings may be unremarkable in osteoarticular chest wall infections and not suggestive of an osteoarticular infection. Causative microbes are frequently identified if specific nucleic acid amplification assays are carried out. In the young pediatric population, there is evidence that Kingella kingae is 1 of the main the main causative pathogens of osteoarticular infections of the chest wall.
C with functional or anatomic asplenia are at high risk for invasive meningococcal disease, espec... more C with functional or anatomic asplenia are at high risk for invasive meningococcal disease, especially with encapsulated strains. Nongroupable (unencapsulated) meningococcal strains, which are commonly associated with asymptomatic nasopharyngeal carriage and considered as nonpathogenic, rarely cause invasive disease. Herein, we report a rare case of meningococcemia due to nongroupable Neisseria meningitidis in a splenectomized child despite meningococcal vaccination. A 10-year-old female presented to the emergency department with acute onset fever, headache and myalgia. Her past medical history included splenectomy for trauma at the age of 9 years. The patient was started on penicillin prophylaxis and vaccinated with 2-dose series of MenACWY-TT and MenB-4C after splenectomy. On physical examination, the patient was found to be febrile to 39.4°C, tachycardic (110 beats/ min) and hypotensive (80/40 mm/Hg). A nonblanchable petechial rash was present on the patient’s abdomen, lower legs and arms. After blood and cerebrospinal fluid cultures were obtained, treatment with empirical intravenous ceftriaxone was started for presumed meningococcemia. Laboratory evaluation showed leukopenia (3600/mm), thrombocytopenia (88,000/mm), elevated C-reactive protein (48 mg/dL) and disseminated intravascular coagulation. Lumbar puncture revealed no evidence of meningitis. Due to persistent hypotension, resuscitation was initiated with intravenous fluids and inotropes, and the patient was transferred to pediatric intensive care unit. On day 2, N. meningitidis (sensitive to ceftriaxone, but resistant to penicillin with a minimum inhibitory concentration of 0.5 mg/L) growth was noted in blood culture, confirming the diagnosis of meningococcemia. The isolate was determined to be nongroupable by both slide agglutination for serogroups A, B, C, E, W, X, Y and Z (Remel, Lenexa, KS) and real-time PCR. She was treated with 10 days of intravenous ceftriaxone and made a full recovery without any sequelae. During
Journal of the Pediatric Infectious Diseases Society, 2019
Moraxella lacunata is a rare coccobacillus associated with eye and upper respiratory tract infect... more Moraxella lacunata is a rare coccobacillus associated with eye and upper respiratory tract infections. It may also have an affinity for bone and joint tissue. We report on 1 case of subacute osteomyelitis of the patella due to M. lacunata that presented as an osteolytic bone lesion in a child.
Sciatic neuropathy (SN) is rarely encountered in the pediatric population. The causes of this mon... more Sciatic neuropathy (SN) is rarely encountered in the pediatric population. The causes of this mononeuropathy are either infectious, immune mediated, toxic, or infiltrative (tumoral). In this article, we presented the case of a 7.5-year-old male child who presented to the emergency department with a painful right lower limb. Magnetic resonance imaging confirmed the diagnosis of subacute osteomyelitis of the ischium, which extended toward the external hip rotators and infiltrated the tissues around the sciatic nerve. Treatment with intravenous antibiotics (flucloxacillin 50 mg/kg/d and gentamicin 10 mg/kg/d) rapidly improved the child's condition and relieved neurological symptoms within a few days. Traumatic and iatrogenic injuries are the most common causes for SN. To our knowledge, this presented case is the first to describe SN due to an infectious process following subacute osteomyelitis.
Introduction: Osteoarticular infections (OAIs) constitute serious paediatric conditions that may ... more Introduction: Osteoarticular infections (OAIs) constitute serious paediatric conditions that may cause severe complications. Identifying the causative organism is one of the mainstays of the care process, since its detection will confirm the diagnosis, enable adjustments to antibiotic therapy and thus optimize outcomes. Two bacteria account for the majority of OAIs before 16 years of age: Staphylococcus aureus is known for affecting the older child, whereas Kingella kingae affects infants and children younger than 4 years old. We aimed to better define clinical characteristic and biological criteria for prompt diagnosis and discrimination between these two OAI. Materials and methods: We retrospectively studied 335 children, gathering 100 K. kingae and 116 S. aureus bacteriologically proven OAIs. Age, gender, temperature at admission, involved bone or joint, and laboratory data including bacterial cultures were collected for analysis. Comparisons between patients with OAI due to K. k...
Nowadays, Kingella kingae (K. kingae) is considered as the main bacterial cause of osteoarticular... more Nowadays, Kingella kingae (K. kingae) is considered as the main bacterial cause of osteoarticular infections (OAI) in children aged less than 48 months. Next to classical acute hematogenous osteomyelitis and septic arthritis, invasive K. kingae infections can also give rise to atypical osteoarticular infections, such as cellulitis, pyomyositis, bursitis, or tendon sheath infections. Clinically, K. kingae OAI are usually characterized by a mild clinical presentation and by a modest biologic inflammatory response to infection. Most of the time, children with skeletal system infections due to K. kingae would not require invasive surgical procedures, except maybe for excluding pyogenic germs’ implication. In addition, K. kingae’s OAI respond well even to short antibiotics treatments, and, therefore, the management of these infections requires only short hospitalization, and most of the patients can then be treated safely as outpatients.
Compartment syndrome is a condition where high pressure within a muscle compartment reduces capil... more Compartment syndrome is a condition where high pressure within a muscle compartment reduces capillary blood perfusion below the level necessary for tissue viability. A variety of injuries and medical conditions may initiate acute compartment syndrome, including fractures, contusions, burns, bleeding disorders, post-ischemic swelling, and gunshot wounds. Exertional compartment syndrome is a well-recognised clinical entity, which can have an acute or chronic presentation, and is associated most often with unaccustomed exercise. This case report discusses a 15-year-old girl who for two years felt transitory pain in the right peroneal compartment when she played sport. After many days of horseback riding, she sustained a sudden increase of the antero-lateral leg pain. The pressure of her lateral leg compartment rose to 100mmHg. Emergent fasciotomy of the lateral compartment of the right leg was performed, and showed partially necrotic peroneal muscles. The reported case is unusual because the pathology was localised to the peroneal compartment only and left the 3 other loges unaffected. Only two other reported cases of exertional compartment syndrome from prolonged horseback riding has been found in the medical literature. The particular mechanism of the peroneal compartment as a result of horseback riding in children is also discussed.
We report an even rarer subtype of this translocation associated with a radial neck fracture and ... more We report an even rarer subtype of this translocation associated with a radial neck fracture and elbow dislocation. This case had clinical importance in that reverse instability was observed compared with the previous reports. Case report A 5-year-old boy was admitted to our emergency center after a fall from a 2 m jungle gym onto his outstretched left hand. The patient complained of left elbow pain and limitation of motion. Initial examination revealed a painful, swollen left elbow without neurovascular problems. The left elbow was held in 50 o flexed position with the forearm in supinated position. The posterior elbow dislocation and radial head fracture were recognized at initial radiographs (Fig. 1). The closed reduction was performed under intravenous sedation and the elbow was immobilized with long arm splint. However, the pain did not subside on the following day and the forearm showed limatation of rotation, especially pronation. The radiographs after reduction were reviewed carefully, and we realized the reversal anatomical relationship of the forearm bone with the humerus. Magnetic resonance image was taken before surgery to evaluate associated soft tissue injury. The radial head was incarcerated between the coronoid process and brachialis insertion (Fig. 2). Closed reduction was planned again. Under general anesthesia, forearm can be extended and supinated, but cannot be pronated beyond the neutral position (Fig. 3). Longitudinal traction and forced supination of the forearm with manual reduction on the radial head failed to achieve reduction. A 1 cm skin incision was made on medial aspect of the proximal ulna. Freer was inserted through the incision, and manual reduction of proximal radius was performed by pushing it laterally (Fig. 4). After reduction, stability of Abstract Proximal radioulnar translocation with radial neck fracture and elbow dislocation is extremely rare. We report a case of a 5-year-old boy who was presented with elbow dislocation, and proximal radioulnar translocation was diagnosed a day after the injury. Mini-open technique was used to reduce the translocation and radial neck fracture. The patient finally regained full range of elbow motion and forearm rotation. This case had clinical importance in that the reverse instability of the elbow was observed compared with the previous reports.
Le signe du carre pronateur est un signe radiologique qui a ete decrit chez l’adulte lors de frac... more Le signe du carre pronateur est un signe radiologique qui a ete decrit chez l’adulte lors de fractures du poignet. En raison des proprietes biomecaniques de l’os en croissance, certaines fractures chez l’enfant sont parfois plus difficilement decelables, raison pour laquelle ce signe est frequemment utilise en pediatrie sans avoir ete valide dans cette population. Par cette etude retrospective cas-temoin, incluant 200 patients, nous avons effectue plusieurs mesures dont l’epaisseur du muscle du carre pronateur et la ligne graisseuse le recouvrant que nous avons normalise au developpement de l’enfant. Les resultats de l’etude confirment qu’il existe une modification du complexe du carre pronateur lors d’une fracture du poignet. Par ailleurs nous avons pu constater que la combinaison entre un epaississement de la ligne graisseuse et une tumefaction du muscle carre pronateur constituaient les criteres morphometriques les plus significatifs et discriminants pour confirmer la presence d’...
Swiss Medical Forum ‒ Schweizerisches Medizin-Forum, 2009
Knochenbrüche an Beinen und Fussgelenken treten bei Kindern und Jugendlichen relativ häufig auf -... more Knochenbrüche an Beinen und Fussgelenken treten bei Kindern und Jugendlichen relativ häufig auf -als Folge von Sportverletzungen oder Unfällen im Strassen verkehr. In der Regel behandelt man solche Brüche konservativ mit einem stabilisierenden Gipsverband. Wegen der fehlenden mechanischen Belastung kann es dann aber zu einem Verlust von Knochenmasse, einem bedeutenden Muskelschwund und in der Folge zu einer Abnahme der Muskelkraft kommen.
Introduction: Mac Farland fracture is a joint fracture of the ankle in children, which involves t... more Introduction: Mac Farland fracture is a joint fracture of the ankle in children, which involves the medial malleolus (Salter-Harris type III or IV) and is frequently associated with a fracture of the distal fibula. These injuries have a major risk of resulting in a medial epiphysiodesis bridge which, in turn, can lead to a varus deformity. As of today, recommended treatment for displacements wider than 2mm is open reduction with screw fixation. The aim of this study is to evaluate functional and radiological results of a new less invasive surgical procedure. Materials and Methods: We retrospectively analyzed a case series of patients who suffered from a Mac Farland fracture and underwent percutaneous screw fixation with arthrographic control. Data collected for each child included age at diagnosis, gender, mechanism and side of injury, radiological Salter-Harris classification of medial and lateral malleolus fracture, size of the fracture line gap before and after treatment, and dur...
Le syndrome douloureux regional complexe (SDRC) est un terme defini par l'Association interna... more Le syndrome douloureux regional complexe (SDRC) est un terme defini par l'Association internationale de l'etude de la douleur afin de decrire une affection douloureuse neurologique affectant un membre et caracterisee par une allodynie, une hyperalgie, des changements neurovasculaires et sudomoteurs, des troubles de la motricite et des changements trophiques cutanes ou ongulaires. Les symptomes peuvent etre divises en deux groupes : les symptomes nocifs positifs, comme l'allodynie et l'hyperalgie, et les symptomes deficitaires negatifs, comme la perte sensorielle et les troubles moteurs. Le SDRC pediatrique differe de la version adulte a bien des egards et cette these passe en revue les specificites pediatriques du SDRC. Les circonstances cliniques precedant un SDRC different tout comme la clinique avec certaines specificites pediatriques telles que l’environnement du patient (famille, ecole), qui constitue un facteur decisif dans la prise en charge des patients pedia...
The authors report a rare case of an unusual primary pyomyositis of the biceps cruralis assigned ... more The authors report a rare case of an unusual primary pyomyositis of the biceps cruralis assigned to Kingella kingae in a 21-month-old girl. The reported case demonstrated that primary pyomyositis may be encountered during invasive infection due to K. kingae even if this manifestation remains rare. This bacterial etiology must, therefore, be evoked when a primary pyomyositis is observed, and this is in particular in children under 4 years of age.
Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 2003
PURPOSE OF THE STUDY Bone and joint infections are challenging therapeutic situations requiring r... more PURPOSE OF THE STUDY Bone and joint infections are challenging therapeutic situations requiring rapid antibiotic therapy as soon as bacteriology specimens have been obtained. Laboratory tests (C reactive protein, erythrocyte sedimentation rate, white cell count) and clinical findings are used to assess therapeutic efficacy. Most of the clinical signs however, particularly in children or after a surgical procedure, are not explicit enough to allow proper assessment of the clinical course under antibiotic therapy. Body temperature is the only parameter currently used in routine practice. But the measurement of body temperature is not always reliable and variations observed during treatment should not always be attributed to treatment failure. The purpose of this work was to assess the significance of changes in body temperature observed in children given effective intravenous antibiotic treatment for bone and joint infections. MATERIAL AND METHODS We reviewed retrospectively the files...
Aim: This retrospective study’s objective was to evaluate osteoarticular infection in infants les... more Aim: This retrospective study’s objective was to evaluate osteoarticular infection in infants less than 12 months of age, with a particular focus on biological features and bacteriological etiology. Material & methods: We retrospectively reviewed the medical records of every infant younger than 12 months old admitted in our institution for a suspected osteoarticular infection between January 1980 and December 2016. Results: Sixty-nine patients records were reviewed, including eight neonates, 16 infants from 1 to 5 months old, and 45 from 6 to 12 months old. Conclusion: Neonates and infants aged from 6 to 12 months old were more exposed to infections. Staphylococcus aureus remained the main pathogen in children <6 months, whereas Kingella kingae has become the most frequently isolated microorganism in infants aged from 6 to 12 months old.
Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and aff... more Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and affect primarily infants and toddlers. Clinical presentation is often vague and nonspecific. Laboratory findings may be unremarkable in osteoarticular chest wall infections and not suggestive of an osteoarticular infection. Causative microbes are frequently identified if specific nucleic acid amplification assays are carried out. In the young pediatric population, there is evidence that Kingella kingae is 1 of the main the main causative pathogens of osteoarticular infections of the chest wall.
C with functional or anatomic asplenia are at high risk for invasive meningococcal disease, espec... more C with functional or anatomic asplenia are at high risk for invasive meningococcal disease, especially with encapsulated strains. Nongroupable (unencapsulated) meningococcal strains, which are commonly associated with asymptomatic nasopharyngeal carriage and considered as nonpathogenic, rarely cause invasive disease. Herein, we report a rare case of meningococcemia due to nongroupable Neisseria meningitidis in a splenectomized child despite meningococcal vaccination. A 10-year-old female presented to the emergency department with acute onset fever, headache and myalgia. Her past medical history included splenectomy for trauma at the age of 9 years. The patient was started on penicillin prophylaxis and vaccinated with 2-dose series of MenACWY-TT and MenB-4C after splenectomy. On physical examination, the patient was found to be febrile to 39.4°C, tachycardic (110 beats/ min) and hypotensive (80/40 mm/Hg). A nonblanchable petechial rash was present on the patient’s abdomen, lower legs and arms. After blood and cerebrospinal fluid cultures were obtained, treatment with empirical intravenous ceftriaxone was started for presumed meningococcemia. Laboratory evaluation showed leukopenia (3600/mm), thrombocytopenia (88,000/mm), elevated C-reactive protein (48 mg/dL) and disseminated intravascular coagulation. Lumbar puncture revealed no evidence of meningitis. Due to persistent hypotension, resuscitation was initiated with intravenous fluids and inotropes, and the patient was transferred to pediatric intensive care unit. On day 2, N. meningitidis (sensitive to ceftriaxone, but resistant to penicillin with a minimum inhibitory concentration of 0.5 mg/L) growth was noted in blood culture, confirming the diagnosis of meningococcemia. The isolate was determined to be nongroupable by both slide agglutination for serogroups A, B, C, E, W, X, Y and Z (Remel, Lenexa, KS) and real-time PCR. She was treated with 10 days of intravenous ceftriaxone and made a full recovery without any sequelae. During
Journal of the Pediatric Infectious Diseases Society, 2019
Moraxella lacunata is a rare coccobacillus associated with eye and upper respiratory tract infect... more Moraxella lacunata is a rare coccobacillus associated with eye and upper respiratory tract infections. It may also have an affinity for bone and joint tissue. We report on 1 case of subacute osteomyelitis of the patella due to M. lacunata that presented as an osteolytic bone lesion in a child.
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Papers by Dimitri Ceroni